European Stroke Journal最新文献

{"title":"Cerebral amyloid angiopathy and amyloid load distribution detected on amyloid-positron emission tomography: A systematic review and meta-analysis.","authors":"Aikaterini Theodorou, Konstantinos Melanis, Athanasia Athanasaki, Lina Palaiodimou, Maria-Ioanna Stefanou, Panagiota-Eleni Tsalouchidou, Efthimios Vassilopoulos, Anastasios Kouzoupis, Marios Themistocleous, Georgios P Paraskevas, Georgios Tsivgoulis, Elias Tzavellas","doi":"10.1177/23969873251349657","DOIUrl":"10.1177/23969873251349657","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited data regarding the amyloid positron emission tomography (PET) imaging among patients with Cerebral Amyloid Angiopathy (CAA). We sought to assess the amyloid load distribution detected on amyloid-PET among CAA patients compared to patients with Alzheimer's Disease (AD), patients with hypertension (HTN) related hemorrhage (ICH) and healthy controls (HC).</p><p><strong>Patients and methods: </strong>A systematic review and meta-analysis of published studies with available data on global and regional amyloid-PET uptake was conducted. Comparisons with respect to amyloid load distribution were investigated using random-effects models based on the ratio of mean (RoM) amyloid-PET uptake. RoM < 1 and RoM > 1 indicate lower and higher global or regional amyloid-PET uptake in CAA compared to another population, respectively.</p><p><strong>Results: </strong>We identified 16 cohorts, comprising 271 CAA patients (mean age: 72 years; women: 46%) versus 130 AD patients (mean age: 73 years; women: 44%), 180 patients with HTN-related ICH (mean age: 66 years; women: 36%) and 61 HC (mean age: 71 years; women: 46%) with available data on amyloid-PET. Global amyloid PET ratio differentiated CAA from AD [RoM: 0.93; 95% CI: 0.90-0.96; <i>p</i> < 0.0001], HTN-related ICH [RoM: 1.25; 95% CI: 1.20-1.31; <i>p</i> < 0.0001], and HC [RoM: 1.26; 95% CI: 1.23-1.29; <i>p</i> < 0.0001]. Occipital amyloid-PET uptake [RoM: 1.20; 95% CI: 1.15-1.26; <i>p</i> < 0.0001] was higher in CAA compared to HTN-related ICH, and Occipital-to-global [RoM: 1.05; 95% CI: 1.03-1.07; <i>p</i> < 0.0001] ratio of amyloid-PET uptake differentiated also CAA from AD.</p><p><strong>Conclusions: </strong>CAA is characterized by a distinct amyloid-PET burden and distribution compared to AD patients, patients with HTN-related ICH and HC. These findings may contribute to the design and conduct of future randomized controlled clinical trials, aiming to treat CAA at preclinical stages.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251349657"},"PeriodicalIF":5.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial injury in patients with acute ischemic stroke: Prevalence and types of triggers of myocardial demand ischemia.","authors":"Helena Stengl, Sophie Böhme, Oskar Richter, Simon Hellwig, Markus G Klammer, Ramanan Ganeshan, Laura Reimann, Simone Lieschke, Regina von Rennenberg, Heinrich J Audebert, Wolfram Doehner, Christian H Nolte, Matthias Endres, Jan F Scheitz","doi":"10.1177/23969873251346008","DOIUrl":"10.1177/23969873251346008","url":null,"abstract":"<p><strong>Introduction: </strong>Acute myocardial injury occurs in about every fourth patient in the early phase after ischemic stroke. It may be caused by an imbalance between myocardial oxygen supply and demand, potentially leading to type 2 myocardial infarction (MI). However, little is known about the prevalence of potential triggers of such demand ischemia in acute stroke.</p><p><strong>Patients and methods: </strong>Consecutive patients with and without post-stroke acute myocardial injury (elevated high-sensitivity cardiac troponin T [hs-cTnT] levels with a rise/fall >20%) were matched for age and sex and retrospectively screened for presence of predefined triggering conditions of myocardial demand ischemia and fulfillment of diagnostic criteria for acute MI.</p><p><strong>Results: </strong>Among 508 stroke patients analyzed (median age 81 [73-86] years, 52% female), predefined potential triggers of demand ischemia were present in 107/254 (42%) patients with acute myocardial injury and in 61/254 (24%) matched controls (adjusted OR 2.30, 95%CI 1.51-3.52, <i>p</i> < 0.001). Patients with a trigger were older, more often female, had more severe strokes, and more often insular cortex involvement. The most prevalent triggers were respiratory failure, sustained hypertension, supraventricular tachyarrhythmia, and hemodynamic shock. MI criteria were fulfilled in 44/254 (17%) patients with acute myocardial injury including 27/44 (61.4%) with a trigger of demand ischemia (i.e. suspected type 2 MI).</p><p><strong>Conclusions: </strong>Conditions triggering a myocardial oxygen demand/supply mismatch are highly prevalent in patients with acute myocardial injury detected after stroke, notably in those fulfilling the criteria of acute MI. Stroke-specific aspects such as stroke severity or lesion location may play a role in the development of such triggers.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251346008"},"PeriodicalIF":5.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with oral anticoagulant non-use at first ischemic stroke in atrial fibrillation: A nationwide study.","authors":"Marko Vilpponen, Aapo L Aro, Olli Halminen, Paula Tiili, Miika Linna, Alex Luojus, Konsta Teppo, Pirjo Mustonen, Jari Haukka, Juha Hartikainen, Ke Juhani Airaksinen, Mika Lehto, Jukka Putaala","doi":"10.1177/23969873251343857","DOIUrl":"10.1177/23969873251343857","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on characteristics and patterns associated with patients with atrial fibrillation (AF) who encounter first-ever ischemic stroke (IS) while not on oral anticoagulation (OAC) therapy.</p><p><strong>Methods: </strong>From a nationwide registry-linkage database including all patients with AF in Finland from 2007 to 2017, we included those with IS after diagnosis of AF and those without IS. Factors associated with non-OAC use among IS patients were examined using logistic regression, with separate models for independent variables and risk scores.</p><p><strong>Results: </strong>Among 174,094 patients with new-onset AF, 11,680 (6.7%) patients (56.9% female; mean age 79.0 years) experienced IS. A total of 7507 (64.3%) of IS patients were not on OAC at the time of IS (mean age 78.9 years; 57.2% female). The proportion of non-OAC decreased from 77.2% to 45.6% over the study period. In the adjusted logistic regression model, the strongest factor associated with non-OAC was CHA₂DS₂-VA score of 0 points (OR 4.561; 95% CI, 3.097-6.718), followed by a score of 1 point (OR 2.382; 95% CI, 1.971-2.879). Other significant independent factors associated with non-OAC use were alcohol abuse (OR 2.282; 95% CI, 1.805-2.885), liver dysfunction (OR 2.120; 95% CI, 1.335-3.367), renal dysfunction (OR 1.430; 95% CI, 1.200-1.703), dementia (OR 1.394; 95% CI, 1.227-1.583), prior myocardial infarction (OR 1.346; 95% CI, 1.181-1.535), age <65 years (OR 1.274; 95% CI, 1.034-1.571), lowest income (OR 1.232; 95% CI, 1.104-1.374), female sex (OR 1.177; 95% CI, 1.077-1.287), and antiplatelets/NSAID use (OR 1.133; 95% CI, 1.042-1.231).</p><p><strong>Conclusions: </strong>Less than 2% of AF patients experienced IS during study period and among these around 63% were without appropriate OAC therapy at the time of the IS. However, decreasing trend of non-OAC use was identified throughout the study period.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251343857"},"PeriodicalIF":5.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study.","authors":"Jorge Pagola, Piergiorgio Lochner, Radim Licenik, Giulio Maria Fiore, Felipe A Montellano, Victor Gonzalez, Valérie Pavlicek, Juan Alvarez-Cienfuegos, Sergio Moral, Roberto Muñoz Arrondo, Alberto Vera, Angel Ruiz, Jesús González Mirelis, Jorge Rodríguez-Pardo, Esther Pérez-David, Juan Manuel García-Sánchez, Lara Ruiz Gómez, Laura Amaya Pascasio, Elvira Carrión Ríos, Tania Rodriguez-Ares, Charigan Abou, María Payá, Laura Guerra, Ana de Arce, Ainhoa Benegas Arostegui, Muhammad Khaled Hasan, Vlatka Reskovic","doi":"10.1177/23969873251345374","DOIUrl":"10.1177/23969873251345374","url":null,"abstract":"<p><strong>Introduction: </strong>Focused cardiac ultrasound (FoCUS) has a high diagnostic yield and a rapid theoretical learning curve. FoCUS can be applied in stroke assessments performed by stroke neurologists when a cardioembolic stroke is suspected.</p><p><strong>Patients and methods: </strong>An international multicenter, prospective validation study was conducted to assess neurologists' ability to perform FoCUS. The FoCUS examination was defined as a simplified 2D transthoracic echocardiography. Neurologists and cardiologists performed the FoCUS independently and blinded. A twenty-question test evaluated neurologists' ability to recognize sources of cardioembolic stroke from recorded FoCUS studies.</p><p><strong>Results: </strong>A total of 432 paired studies involving 216 patients were conducted across 11 centers. No significant differences were found between neurologists and cardiologists in detecting: Left Ventricle (LV) dysfunction (7.4% vs 7.9%, <i>p</i> = 0.834), LV dilation (2.8% vs 2.3%, <i>p</i> = 0.766), VC collapsibility (7.2% vs 9.1%, <i>p</i> = 0.501), Right Ventricle dysfunction (0.9% vs 0.9%, <i>p</i> = 0.999), and pericardial effusion (0.5% vs 1.9%, <i>p</i> = 0.212). Cohen Kappa showed substantial agreement for LV dysfunction (0.640), moderate for LV dilation (0.589), and fair for VC collapsibility (0.226). Neurologists demonstrated 93.82% sensitivity and 92.92% specificity for detecting embolic sources. Success rate for LV akinesia was 88% (16/18), LV dysfunction 83% (15/18), complex aortic plaque 88% (16/18), and mitral stenosis 55% (10/18).</p><p><strong>Discussion and conclusion: </strong>Properly trained neurologists can reliably perform FoCUS, particularly for assessing LV function and dilation, with better results in patients with favorable echocardiographic windows. While VC assessment requires further training, neurologists demonstrated high accuracy in identifying cardioembolic sources (over 90% of cases correctly identified). This study supports implementing standardized FoCUS training for neurologists through collaboration with cardiology specialists to enhance stroke diagnostics and management.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251345374"},"PeriodicalIF":5.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic treatment of cervical arterial dissection: Big data needed to inform long-term management.","authors":"Raffaele Ornello, Matteo Foschi","doi":"10.1177/23969873251347117","DOIUrl":"10.1177/23969873251347117","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251347117"},"PeriodicalIF":5.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor: Antithrombotic treatment of cervical arterial dissection: Big data needed to inform long-term management.","authors":"Lukas S Enz, Josefin E Kaufmann, Christopher Traenka, Stefan T Engelter","doi":"10.1177/23969873251349065","DOIUrl":"10.1177/23969873251349065","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251349065"},"PeriodicalIF":5.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing and outcome prediction of intravenous thrombolysis in posterior circulation stroke: Insights from the Austrian Stroke Unit Registry.","authors":"Alexander Tinchon, Dominika Mikšová, Wilfried Lang, Stefan Krebs, Elisabeth Freydl, Christian Baumgartner, Oliver Friedrich, Stefan Oberndorfer, Marek Sykora","doi":"10.1177/23969873251341770","DOIUrl":"10.1177/23969873251341770","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior circulation (PC) stroke is underrepresented in most large-scale trials. While the importance of the onset-to-needle time (ONT) for intravenous thrombolysis (IVT) in anterior circulation stroke is well established, data on PC stroke are lacking. This study aimed to investigate how ONT affects functional outcome after IVT and to identify additional predictors of outcome in PC stroke.</p><p><strong>Patients and methods: </strong>IVT-treated PC stroke patients included in the nationwide Austrian Stroke Unit Registry between 2003 and 2024 were retrospectively analyzed. The primary outcome measure was the excellent (mRS 0-1) and non-excellent (mRS 2-6) functional outcome at 90 days. The secondary outcome measure was the occurrence of severe intracranial hemorrhage (sICH). Associations between ONT as continuous variable, clinical predictors, and functional outcomes were assessed using ordinal and binomial logistic regression models. A cut-off point for the transition from excellent to non-excellent outcome was determined by maximizing the odds ratio metric. The effect of ONT on sICH was analyzed dichotomously in time intervals of 0-150 min and 151-300 min.</p><p><strong>Results: </strong>Of 11,025 eligible patients with PC stroke, 1,359 (12.3%) were treated with IVT, resulting in more frequent excellent functional outcome in patients treated with IVT compared to best medical treatment (BMT) in the ordinal logistic regression (adjusted odds ratio (aOR) 1.31, 95% CI 1.16-1.47, <i>p</i> < 0.001). Correspondingly, binomial logistic regression showed fewer non-excellent functional outcomes in patients treated with IVT compared to BMT (aOR 0.73, 95% CI 0.63-0.85, <i>p</i> < 0.001). The odds of an excellent functional outcome were increased within the first 282 min, with a pronounced treatment benefit in the first 122 min. The transition cut-off point was found to be at 258 min. sICH occurred in 2.8% and was unrelated to ONT (aOR 1.28, 95% CI 0.55-2.91, <i>p</i> = 0.552). Overall, women had lower IVT rates (11.3% vs 13.0%, <i>p</i> = 0.007) and were more likely to experience a non-excellent outcome (aOR 1.31, 95% CI 1.19-1.45, <i>p</i> < 0.001), but had similar functional outcomes compared to men when treated with IVT (aOR 1.03, 95% CI 0.74-1.43, <i>p</i> = 0.883).</p><p><strong>Discussion and conclusion: </strong>A treatment benefit of IVT in PC stroke was observed within 4.5 h of stroke onset, with its maximum within the first 2 h. Women should receive special attention as they may be at a prognostic disadvantage due to lower IVT rates and less favorable overall outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251341770"},"PeriodicalIF":5.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden.","authors":"Johan Wassélius, Emma Hall, Alex Szolics, Fabian Arnberg, Hozan Radhi, Mia von Euler, Per Wester, Teresa Ullberg, Tobias Cronberg, Nicklas Ennab Vogel, Magnus Esbjörnsson, Fredrik Jonsson, Tommy Andersson, Bo Norrving, Björn M Hansen","doi":"10.1177/23969873251347098","DOIUrl":"10.1177/23969873251347098","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for <i>procedural</i> and <i>implementational effectiveness</i>.</p><p><strong>Methods: </strong>A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.</p><p><strong>Results: </strong>Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%-12.4%, in 2022).</p><p><strong>Conclusions: </strong>By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251347098"},"PeriodicalIF":5.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrinogen time course in acute ischemic stroke patients treated with intravenous thrombolysis with alteplase or tenecteplase.","authors":"Aikaterini Theodorou, Klearchos Psychogios, Odysseas Kargiotis, Apostolos Safouris, Maria Chondrogianni, Eleni Bakola, Konstantinos Melanis, Stella Fanouraki, Frantzeska Frantzeskaki, Eftihia Polyzogopoulou, Georgios Magoufis, Marios Themistocleous, Lina Palaiodimou, Maria-Ioanna Stefanou, Guillaume Turc, Andrei V Alexandrov, Georgios Tsivgoulis","doi":"10.1177/23969873251345387","DOIUrl":"10.1177/23969873251345387","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist on intravenous thrombolysis (IVT) effect on fibrinogen depletion, and on possible associations between low fibrinogen levels and hemorrhagic complications, among acute ischemic stroke (AIS) patients.</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study evaluating fibrinogen levels prior to IVT and at two prespecified timepoints following IVT end (2 and 24 h). Safety and efficacy outcomes were assessed. Fibrinogen depletion was defined as reduction < 200 mg/dl, or as reduction ⩾ 50% of baseline fibrinogen levels after 2 and 24 h from IVT. Furthermore, we conducted a systematic review and meta-analysis, comparing fibrinogen level changes from baseline to a timeframe of 2-12 h, and to 24 h post-IVT between patients receiving alteplase versus tenecteplase.</p><p><strong>Results: </strong>One hundred and sixteen AIS patients, treated with IVT (alteplase = 81, tenecteplase = 35) were included in this study. Alteplase was associated with higher rates of fibrinogen depletion, observed in 2 (38% vs 0%; <i>p</i>-value < 0.001) and 24 h (26% vs 0%; <i>p</i>-value: 0.002) post-IVT, compared to tenecteplase. Three symptomatic intracranial hemorrhages (sICH) and one major extracranial bleeding were observed in patients receiving alteplase (two out of four with fibrinogen depletion) and one sICH without associated fibrinogen depletion was documented in the tenecteplase subgroup. Major hemorrhagic complications were numerically higher in patients with fibrinogen depletion (6.5% vs 3.5%, <i>p</i> = 0.609). Fibrinogen depletion was documented in 50% of alteplase-treated patients complicated with sICH or major extracranial bleeding and in 0% of respective tenecteplase-treated patients. Two cohorts were included in the meta-analysis. Mean relative changes of fibrinogen levels from baseline to a timeframe of 2-12 h post-IVT (RoM: 9.84; 95% CI: 9.63-10.05) were significantly higher in patients receiving alteplase.</p><p><strong>Discussion and conclusions: </strong>Fibrinogen depletion was observed only in AIS patients receiving alteplase and was associated with numerically higher rates of major hemorrhagic complications. These findings require independent confirmation in larger, international cohort studies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251345387"},"PeriodicalIF":5.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in outcomes after endovascular therapy with prior antiplatelet use: A study from the EVA-TRISP registry.","authors":"Roberta Noseda, Federico Rea, Giovanni Bianco, Elias Auer, Mirjam R Heldner, Eike I Piechowiak, Tomas Dobrocky, Patrik Michel, Susanne Wegener, Hakim Baazaoui, Philipp Baumgartner, Sami Curtze, Nicolas Martinez-Majander, Miranda Nybondas, Andrea Zini, Stefano Forlivesi, Matteo Paolucci, Gian Marco De Marchis, Tolga Dittrich, Paul J Nederkoorn, Nabila Wali, Mira Katan, Stefan Engelter, Henrik Gensicke, Simon Trüssel, Alessandro Pezzini, Mauro Magoni, João Pedro Marto, Maria Brás Monteiro, Ronen R Leker, Tamer Jubeh, Visnja Padjen, Carlo W Cereda","doi":"10.1177/23969873251346016","DOIUrl":"10.1177/23969873251346016","url":null,"abstract":"<p><strong>Introduction: </strong>This study assessed sex differences in outcomes after mechanical thrombectomy (MT) with prior antiplatelet use using the EVA-TRISP multinational registry.</p><p><strong>Patients and methods: </strong>A cohort of consecutive patients (2015-2023) treated with MT was analysed by sex and prior antiplatelet use in multivariable logistic regression models. Primary outcomes were in-hospital symptomatic intracranial haemorrhage (sICH) and the 3-month modified Rankin Scale (mRS) score.</p><p><strong>Results: </strong>Among 7472 patients (47.9% females, older than males: 77 vs 72 years, <i>p</i> < 0.0001), sICH rates were similar (females 4.6%, males 4.4%, <i>p</i> = 0.405). The odds of sICH were not influenced by sex (adjusted odds ratio, aOR, 0.99, 95% confidence interval, CI, 0.77-1.28) or prior antiplatelet use (single therapy: aOR 1.28, 95% CI 0.95-1.73; dual therapy: aOR 0.81, 95% CI 0.29-2.31). No significant interactions were found between sex and antiplatelet use (<i>p</i> = 0.73 for single, <i>p</i> = 0.71 for dual therapy). Females had worse 3-month ordinal mRS scores than males (<i>p</i> < 0.0001), but the odds of a higher mRS score were not associated with sex (aOR 1.03, 95% CI 0.93-1.13) or prior antiplatelet use (single: aOR 1.03, 95% CI 0.91-1.16; dual: aOR 1.16, 95% CI 0.82-1.64). No interactions were found between sex and antiplatelet use for mRS (<i>p</i> = 0.78 for single, <i>p</i> = 0.29 for dual therapy).</p><p><strong>Discussion and conclusions: </strong>This study showed that there is no apparent interaction between patient sex and prior use of antiplatelets in relation to safety and functional outcomes of MT. Therefore, there is no reason to support a different decision-making approach by practicing physicians regarding MT in females and males previously taking antiplatelets.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251346016"},"PeriodicalIF":5.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}